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Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.

Journal article
Authors Rebecka Husdal
Eva Thors Adolfsson
Janeth Leksell
Björn Eliasson
Stefan Jansson
Lars Jerdén
Jan Stålhammar
Lars Steen
Thorne Wallman
Ann-Marie Svensson
Andreas Rosenblad
Published in Primary care diabetes
Volume 13
Issue 2
Pages 176-186
ISSN 1878-0210
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 176-186
Language en
Keywords Aged, Biomarkers, blood, Blood Glucose, drug effects, metabolism, Cross-Sectional Studies, Diabetes Mellitus, Type 2, blood, diagnosis, drug therapy, epidemiology, Female, Health Care Surveys, Humans, Hypoglycemic Agents, therapeutic use, Male, Middle Aged, Primary Health Care, standards, Quality Improvement, standards, Quality Indicators, Health Care, standards, Sweden, epidemiology
Subject categories Diabetology


To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs' results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05).This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs' QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

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